Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection
Background and Aims: Given the risk of intestinal resection for Crohn’s disease, postoperative treatment may be informed by several risk factors, including resection type. We compared postoperative treatment strategies for Crohn’s disease between emergent/urgent vs elective resection. Methods: We id...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Gastro Hep Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S277257232200098X |
| _version_ | 1818480020490813440 |
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| author | Joehl T. Nguyen Edward L. Barnes Carolyn T. Thorpe Karyn B. Stitzenberg Casey R. Tak Alan C. Kinlaw |
| author_facet | Joehl T. Nguyen Edward L. Barnes Carolyn T. Thorpe Karyn B. Stitzenberg Casey R. Tak Alan C. Kinlaw |
| author_sort | Joehl T. Nguyen |
| collection | DOAJ |
| description | Background and Aims: Given the risk of intestinal resection for Crohn’s disease, postoperative treatment may be informed by several risk factors, including resection type. We compared postoperative treatment strategies for Crohn’s disease between emergent/urgent vs elective resection. Methods: We identified patients with intestinal resection for Crohn’s disease between 2002 and 2018 using the MarketScan databases. We classified emergent/urgent resections as those occurring after emergency department admission or after the second day of admission. We estimated adjusted risk differences for the association between resection type (emergent/urgent vs elective) and 6-month postoperative medication strategy (biologic monotherapy, biologic combination therapy with an immunomodulator, immunomodulator monotherapy, other nonbiologic medication for Crohn’s [5-aminosalicylates, antibiotics, and corticosteroids], or no medications for Crohn’s). Results: During 6 months after resection among 4187 patients, 23% received biologic monotherapy, 6% received combination therapy, 16% received immunomodulator monotherapy, and 36% received other nonbiologics. Compared with elective resection, emergent/urgent resection was associated with more common use of “other nonbiologic” medications (risk difference 6.4%; 95% confidence interval [CI] 2.8%, 10.0%), but less common use of biologic monotherapy (risk difference −3.2%; 95% CI −6.2%, −0.1%) and no medications (risk difference −3.6%; 95% CI −6.6%, −0.6%). Conclusion: Although patients with emergent/urgent resection may benefit from more aggressive postoperative therapy, there was evidence that emergent/urgent resection was more associated than elective resection with postoperative use of nonbiologics for Crohn’s disease. Future studies of treatment patterns and comparative effectiveness of postoperative treatment strategies for Crohn’s patients should consider these differences between resection types, which may be important drivers of longer term outcomes. |
| first_indexed | 2024-12-10T11:17:34Z |
| format | Article |
| id | doaj.art-a5c6eae6fa83497195df1e1b53a6fdb6 |
| institution | Directory Open Access Journal |
| issn | 2772-5723 |
| language | English |
| last_indexed | 2024-12-10T11:17:34Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gastro Hep Advances |
| spelling | doaj.art-a5c6eae6fa83497195df1e1b53a6fdb62022-12-22T01:51:06ZengElsevierGastro Hep Advances2772-57232022-01-0115894904Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal ResectionJoehl T. Nguyen0Edward L. Barnes1Carolyn T. Thorpe2Karyn B. Stitzenberg3Casey R. Tak4Alan C. Kinlaw5Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North CarolinaCenter for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDivision of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina; Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PennsylvaniaDivision of Surgical Oncology, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North CarolinaDivision of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North CarolinaDivision of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Correspondence: Address correspondence to: Alan C. Kinlaw, PhD, MSPH, University of North Carolina School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, North Carolina 27599.Background and Aims: Given the risk of intestinal resection for Crohn’s disease, postoperative treatment may be informed by several risk factors, including resection type. We compared postoperative treatment strategies for Crohn’s disease between emergent/urgent vs elective resection. Methods: We identified patients with intestinal resection for Crohn’s disease between 2002 and 2018 using the MarketScan databases. We classified emergent/urgent resections as those occurring after emergency department admission or after the second day of admission. We estimated adjusted risk differences for the association between resection type (emergent/urgent vs elective) and 6-month postoperative medication strategy (biologic monotherapy, biologic combination therapy with an immunomodulator, immunomodulator monotherapy, other nonbiologic medication for Crohn’s [5-aminosalicylates, antibiotics, and corticosteroids], or no medications for Crohn’s). Results: During 6 months after resection among 4187 patients, 23% received biologic monotherapy, 6% received combination therapy, 16% received immunomodulator monotherapy, and 36% received other nonbiologics. Compared with elective resection, emergent/urgent resection was associated with more common use of “other nonbiologic” medications (risk difference 6.4%; 95% confidence interval [CI] 2.8%, 10.0%), but less common use of biologic monotherapy (risk difference −3.2%; 95% CI −6.2%, −0.1%) and no medications (risk difference −3.6%; 95% CI −6.6%, −0.6%). Conclusion: Although patients with emergent/urgent resection may benefit from more aggressive postoperative therapy, there was evidence that emergent/urgent resection was more associated than elective resection with postoperative use of nonbiologics for Crohn’s disease. Future studies of treatment patterns and comparative effectiveness of postoperative treatment strategies for Crohn’s patients should consider these differences between resection types, which may be important drivers of longer term outcomes.http://www.sciencedirect.com/science/article/pii/S277257232200098XCrohn’s DiseasePostoperative TreatmentIntestinal Resection |
| spellingShingle | Joehl T. Nguyen Edward L. Barnes Carolyn T. Thorpe Karyn B. Stitzenberg Casey R. Tak Alan C. Kinlaw Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection Gastro Hep Advances Crohn’s Disease Postoperative Treatment Intestinal Resection |
| title | Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection |
| title_full | Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection |
| title_fullStr | Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection |
| title_full_unstemmed | Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection |
| title_short | Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection |
| title_sort | postoperative use of biologics was less common among patients with crohn s disease with emergent urgent vs elective intestinal resection |
| topic | Crohn’s Disease Postoperative Treatment Intestinal Resection |
| url | http://www.sciencedirect.com/science/article/pii/S277257232200098X |
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